Our objective was to try to evaluate lung affection and to correlate an easier and cheaper method with the high-resolution computed tomography (HRCT) findings in patients with RA. Thirty-six RA patients were selected for HRCT lung scan (twelve patients with altered pulmonary function test (PFT) and 24 with normal PFT). The American Thoracic Society criteria were followed for the pulmonary test. Clinical and laboratory variables were recorded. A statistical analysis was done by Kaplan-Meyer survival curve and ROC curve. When HRCT was evaluated in all patients, only sixteen had an HRCT normal and twenty patients showed some radiologic alteration under HRCT such as: pleural thickness, bronchiectasis, interstitial pattern, micro-nodules pattern, ground-glass opacity, and a reticular pattern. A logistic regression showed that methotrexate use, evolution of the disease (beta 0.018), and FEV1 (beta 0.89) were statistically associated with HRCT alterations. A projection of patients, free from event (HRCT lung scan altered), was obtained through a Kaplan-Meyer analysis, using FEV1 as a predictor over time. The curve shows that in the next 240 months (20 years) nearly 40% of the patients with rheumatoid arthritis will have FEV1 values less than 80% of the normal values predicted for the same age and sex. The FEV1 values have demonstrated a good correlation between PFT and HRCT lung scan. Therefore, they provide an accessible tool for tracking early pulmonary alterations. Methotrexate use and time evolution of the disease have been associated with altered FEV1.

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Funding Acknowledgements Type of funding sources: None. Introduction Cardiac magnetic resonance (CMR) is determinant for defining the final diagnosis in patients with an acute troponin rise of non-ischemic etiology. However, depending on the pre-test diagnostic suspicion, the usefulness of CMR to improve the final diagnosis may vary. Alluvial diagrams are not commonly applied to medicine fields, however, these charts offer a unique opportunity to visualize the changes in diagnosis after a specific test. Purpose The aim of the study was to define in which patients CMR may be more efficient for defining the final diagnosis of an acute rise of troponin. To reach our objective we applied for the first time an alluvial diagram to a cohort of patients undergoing CMR after an acute rise of troponins. Methods All consecutive patients admitted during a 2-year-period in our tertiary hospital with an acute non-ischemic troponin rise who underwent CMR were retrospectively included in the study. In patients with a suspicion of myocardial infarction, ischemic etiology was previously ruled out with an invasive coronary angiogram with concomitant intravascular imaging when necessary. Based on patients´ clinical characteristics, wall motion abnormalities, ECG findings and cardiac biomarkers pattern a pre-CMR preliminary diagnostic suspicion was made: suspicion of Takotsubo syndrome, suspicion of myocarditis, non-ST-elevation troponin rise without a specific diagnostic suspicion or ST-elevation troponin rise without a specific diagnostic suspicion. Based on CMR findings a final diagnosis was obtained. The changes between pre-CMR and post-CMR diagnosis were analyzed using an alluvial diagram. Results A total of 64 patients were included. Thirty patients (47%) underwent coronary angiography which ruled out obstructive lesions. Previous to CMR, a high suspicion of Takostubo syndrome and myocarditis was present in 25 (39%) and 14 (22%) patients, respectively. Despite invasive angiogram, 1 ST-elevation troponin rise and 20 non-ST elevation troponin rise underwent CMR without a specific diagnostic suspicion. The diagnostic changes after CMR are presented in Figure 1. Takotsubo syndrome was confirmed in the 96% of patients with a high suspicion of Takotsubo syndrome and myocarditis was confirmed in all the patients with a high suspicion of myocarditis. Among patients without a specific suspicion of disease a final diagnosis was reached in 71% of them. Specifically, Takotsubo syndrome, myocardial damage, myocarditis and myocardial infarction were diagnosed in 25%, 10%, 30% and 10% of the patients, respectively. Conclusions For the first time an alluvial diagram describes the impact of CMR for defining the etiology of an acute non-ischemic rise of troponin. Based on our results, CMR has a confirmatory role in patients with a high suspicion of Takotsubo syndrome and myocarditis, whilst CMR findings provide a final diagnosis in the 71% of patients without a previous specific etiologic suspicion. Abstract Figure.

Background Cardiac computed tomography angiography (CCTA) is precise in noninvasive coronary atherosclerosis characterization but its value in the diagnosis of intracoronary thrombus remains unknown. Therefore, our aim was to evaluate CCTA for intracoronary thrombus and stenosis detection in patients with acute coronary syndromes with high thrombus burden selected for a deferred stenting strategy. MethodsWe systematically performed a CCTA in consecutive patients following a deferred stenting strategy, 24 h before the scheduled repeated coronary angiography including optical coherence tomography (OCT) imaging. Intracoronary thrombus and residual stenosis were blindly and independently evaluated by both techniques. Agreement was determined per lesion using the weighted Kappa (K) coefficient and absolute intraclass correlation coefficient (ICC). A stratified analysis according to OCT-detected thrombus burden was also performed. ResultsThirty lesions in 28 consecutive patients were analyzed. Concordance between CCTA and repeated coronary angiography in thrombus detection was good (K = 0.554; P < 0.001), but both showed poor agreement with OCT. CCTA needed >11.5% thrombus burden on OCT to obtain adequate diagnostic accuracy. The lesions detected by angiography were more frequently classified as red thrombus (76.5 vs. 33.3%; P = 0.087) on OCT. CCTA showed an excellent concordance with coronary angiography in diameter measurement (ICC = 0.85; P < 0.001) and was able to identify all the patients with severe residual stenosis. ConclusionsAlthough CCTA showed just a good concordance with angiography in intracoronary thrombus detection, the agreement in residual stenosis was excellent. Thus, in patients with a high-thrombus burden selected for a deferred stenting strategy CCTA may substitute repeat angiography.

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